CurrentPremera BluecrossPolicy N/A

Modifier RA — Replacement of member-owned DME/Orthotic/Prosthetic Items

Defines when Premera recognizes modifier RA on professional claims to indicate replacement of member-owned durable medical equipment (DME), orthotic, or prosthetic items and explains required accompanying modifiers and documentation; applies to Premera and affiliated lines of business.

Policy Summary

PayerPremera Bluecross

PolicyModifier RA — Replacement of member-owned DME/Orthotic/Prosthetic Items

Policy CodePolicy N/A

Change TypeArchived — redirected to Rental to Purchase policy

Effective DateN/A

Next Review DateApr 7, 2025

Key ActionAppend RA plus RR-RA for first rental month or NU-RA for purchased replacements and include a narrative explaining reason/need; claims without RR-RA or NU-RA will be denied.

SourceLink

POLICY UPDATE CHANGES

This policy is archived effective May 7, 2026 and readers are directed to the Durable Medical Equipment (DME)/Home Medical Equipment (HME): Rental to Purchase policy.

5 yearsreasonable useful lifetime (RUL) for member-owned DME before replacement recognition

RR-RA or NU-RA requiredmodifiers required when replacing rented vs purchased member-owned DME

Deniedmissing required replacement modifiers leads to denial

Premera & affiliateslines of business covered by policy

When Replacements of Member-Owned DME Are Recognized

Replacement recognition and submission criteria

Covered when ALL of the following are met:

Replacement is recognized when the member-owned DME, orthotic, or prosthetic item is being replaced during or after its reasonable useful lifetime (RUL) of 5 years for one or more of the following reasons: reasonable deterioration over time; item is non-functional and cannot be repaired; loss/theft; accidental or irreparable damage; needed due to change in member's medical condition; or replacement cost is less than repair cost.

When replacing a member-owned item, modifier RA must be appended to the procedure code along with either a rental modifier or a purchase modifier, and supporting documentation must be available.

If the replacement item is rented: the procedure code must be submitted with RR-RA on the first rental month claim only; that claim must include a narrative explaining the reason/need; the patient's medical records must document the reason/need and be available for review; subsequent rental months must be submitted with the rental modifier RR.

If the replacement item is purchased outright: the procedure code must be submitted with NU-RA and include a narrative explaining the reason/need; the patient's medical records must document the reason/need and be available for review.

Policy Summary

PayerPremera Bluecross

PolicyModifier RA — Replacement of member-owned DME/Orthotic/Prosthetic Items

Policy CodePolicy N/A

Change TypeArchived — redirected to Rental to Purchase policy

Effective DateN/A

Next Review DateApr 7, 2025

Key ActionAppend RA plus RR-RA for first rental month or NU-RA for purchased replacements and include a narrative explaining reason/need; claims without RR-RA or NU-RA will be denied.

SourceLink

On This Page

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Billing and Submission Requirements for Replacements

Billing Rule

Modifier use and claim submission requirements

Append modifier RA to the procedure code when replacing a member‑owned DME, orthotic, or prosthetic item during or after the item's reasonable useful lifetime (RUL) of 5 years for reasons such as reasonable deterioration, non‑functional/unrepairable items, loss/theft, accidental/irreparable damage, change in medical condition, or when replacement cost is less than repair cost. When replacing a rented item for the first rental month, append modifiers RR‑RA and include a narrative on the claim explaining the reason/need; also maintain medical record documentation available upon request. For purchases, append NU‑RA to the procedure code and include a narrative explaining the reason/need; medical records must document the replacement and be available upon request. Subsequent rental months must be billed with RR (rental modifier) only. Claims for replacement submitted without RR‑RA or NU‑RA will be denied.

Append modifier RA to the procedure code when replacing member‑owned DME/orthotic/prosthetic after 5‑year RUL.
If replacing a rented item: use RR‑RA on the first rental month claim and include a narrative explaining the reason/need; retain supporting medical records.
Subsequent rental months: submit with modifier RR only.
If purchasing the replacement outright: use NU‑RA and include a narrative explaining the reason/need; retain supporting medical records.
Claims for replacement submitted without RR‑RA or NU‑RA will be denied.

Terms and Modifier Definitions

Modifier RAReplacement of a DME, Orthotic or Prosthetic Item

When to append RAAppend modifier RA to the procedure code when replacing member‑owned DME/orthotic/prosthetic items at or after the 5‑year RUL

Combined with rental or purchase modifiersRA must be appended along with either a rental DME modifier (e.g., RR) or a new purchase DME modifier (e.g., NU)

RR/LL/KR

RRRental — use RR for rental billing; if replacement occurs when item is rented, submit RR‑RA on first rental month; subsequent months use RR

LLLease/Rental — indicates lease or rental arrangement

KRRental item — billing for partial month (used for daily rentals)

NU/NR/UE

NUNew equipment (purchase) — when purchased outright append NU‑RA to the DME procedure code and include a narrative explaining reason/need

NRNew when rented — purchase modifier used when equipment is new at time of rental

UEUsed DME — indicates used durable medical equipment

OpenPayer

Modifier RA — Replacement of member-owned DME/Orthotic/Prosthetic Items

When Replacements of Member-Owned DME Are Recognized

Modifiers, Codes, and Reasonable Useful Lifetime

Billing and Submission Requirements for Replacements

Terms and Modifier Definitions

RA	Replacement of a DME, Orthotic or Prosthetic Item
RR	Rental
LL	Lease/Rental
KR	Rental item -billing for partial month (used for daily rentals)
NU	New equipment
NR	New when rented
UE	Used DME